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South Dakota rates for HCPCS 50920

Closure Ureterocutaneous Fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$834.36 / $834.36 / $834.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.37 / $834.36 / $2,532.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,927.22 / $1,975.80 / $2,469.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,075.89 / $1,410.07 / $2,356.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.00 / $1,811.66 / $6,562.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.35 / $2,180.11 / $2,686.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,454.00 / $1,927.22 / $2,333.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.59 / $1,467.33 / $1,712.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.00 / $1,578.06 / $2,454.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,699.40 / $1,999.20 / $2,079.19